Recipient Consent Form

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Now please fill out and sign our Consent for Pasteurised Human Milk Recipient form below...

For Pasteurised Donor Human Milk Recipient



Human milk is the standard food for infants and young children, including premature and sick newborns, with rare exceptions. Human milk provides optimal nutrition, promotes normal growth and development, and reduces the risk of illness and disease. The unique composition of human milk, which includes nutrients, enzymes, growth factors, hormones and immunologic and anti-inflammatory properties, has not been duplicated.


When mother’s own milk is not available or there is not sufficient volume, pasteurised donor human milk from a recognised donor human milk bank is the next best option. Pasteurised donor human milk retains most of its bioactive properties, which protect the baby from infection while the nutritional components of the milk are easy for the baby to digest. Do not add anything to a donor milk feed unless ordered by your baby’s Doctor or Lactation Consultant. Once defrosted the milk is to be given to your baby within 24hours or discarded. Do not refreeze pasteurised donor milk.

Mothers Milk Bank Charity

The Mothers Milk Bank Charity provides Pasteurised Donor Human Milk (PDHM) for babies who do not have human milk available. The mothers’ milk bank has developed strict guidelines for their operation and administration, which are consistent with the guidelines of the Human Milk Banking Association of North America, to ensure that the safest possible product is provided.


All donors provide milk on a voluntary basis. Only healthy women who are non-smokers and have a healthy lifestyle are accepted as donors. All potential donors are screened by verbal and written medical health questionnaire and blood screening. The blood screening tests for donors includes tests for HIV, HTLV, syphilis and Hepatitis B and C.


The donor is screened, the milk is pasteurised, and the milk is screened to ensure it is free ofmicrobiological growth, before it is released from the milk bank. The mothers milk bank keeps a record of all milk supplied from donor to recipient baby There is no cost to infants for pasteurised donor human milk provided. The Mothers Milk Bank Charity asks for a donation in support of pasteurised human milk giving life to human babies Go to

Please sign the attached authority so that your baby can receive donor milk:


give consent for my baby

to receive Pasteurised Donor Human Milk (PDHM). I understand that due to its limited supply pasteurised donor human milk can only be supplied to my baby when available.

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Please sign the form

You will be emailed a copy of this form.